Medicines

Prohibited Drugs

The following categories of drugs must be fully avoided during the time we are using PRP Stem Cell Therapy, or other regenerative injections such as prolotherapy. In simple terms, these substances are the Kryptonite to your super cell powers. Start one of our rebuilding processes, take one of these medicines, and figure that the process will be aborted for the rest of that month or more. Under most below sections, we will estimate about how long you need to be off of each type of prohibited medicine before beginning or resuming our growth and repair procedures. Then, you’ll need to be 100% off of these medicines throughout the many months we are repairing your tissues, and for a month after our last procedure.

NSAID Anti-inflammatory Drugs

NSAID means Non-Steroidal Anti-Inflammatory Drug. This includes many over the counter drugs you can purchase at many kinds of stores without a prescription: Ibuprofen, Advil, Aleve, Motrin, aspirin and many others. It also includes prescription medicines such as Celebrex, Vioxx and many others. Note that NSAIDs are also present in some topical crèmes and ointments. NSAIDs chemically shut down natural inflammation that is part of the way your body heals. While in some ways these medicines are clearly not as damaging as the others in this prohibited drug list, they do abort our repair processes, and they have some other negative side effects.

The most significant recent major aspirin research was the publication of a massive study in the Journal of the American Medical Association on January 22nd, 2019. This huge study of 164,225 participants concluded that “there is insufficient evidence to recommend routine aspirin use in the prevention of heart attacks, stroke, and cardiovascular deaths in people without cardiovascular disease.” As a result, the FDA changed its position to be against preventive use of aspirin. Here is Dr. Mercola’s most recent roundup of that newest aspirin information and more.

We require that NSAID anti-inflammatory drugs be stopped at least one week prior to beginning PRP Stem Cell Therapy or any other regenerative procedures. Then NSAIDs need to be fully avoided during the months of PRP therapy, and for at least one month after the last procedure. And, you’re probably best off never taking these drugs.

Corticosteroids

This is a more serious category of drugs. Not only would drugs in this category abort our tissue regeneration procedures, but these drugs can commonly have even more serious and dramatic adverse effects. In injectable form it might be called a cortisone injection, or a steroid injection, or it might be spoken of by specific drug names such as DepoMedrol, Celestone, or others. Orally, it might be called Prednisone or Prednisolone. Dose matters, and very small doses, within the range that your body would normally make in its own, may be acceptable. But, corticosteroid use outside of the amounts normally made by the body suppress your own production in the adrenal glands, and in effect turns off your immune system, increasing infection risk, literally putting stem cells to sleep, and posing a threat of damaging connective tissues, and weakening ligaments and tendons, particularly where injected, or when taken orally in greater doses for longer periods of time. Because of this, doctors in the past decade have mostly backed off of injecting it into the Achilles’ tendon, as such injection too often led to rupture of the Achilles’ tendon. But, sadly, injections in other structures continue, perhaps because the damage done is not so clearly seen as with Achilles’ rupture.

Because of how much stronger corticosteroids are than NSAIDs, corticosteroids need to be stopped at least 6 or ideally 8 weeks prior to beginning PRP Stem Cell Therapy. Some surgeons demand that corticosteroid injections be stopped for 6 months prior to some surgeries.

This should scare you. If you read about these antibiotics, look at the studies and articles below, and watch the Canadian TV documentary, it would be reasonable to be horrified that such damaging medicines are given out so freely, and without explanation of the risks.

Fluoroquinolones are a family of antibiotics that include the following:

Cipro (ciprofloxacin)

Levaquin (levofloxacin)

Avelox (moxifloxacin)

Factive (gemifloxacin)

Noroxin (norfloxacin)

Floxin (ofloxacin)

NegGram (nalidixic acid)

Baxdela (delafloxacin)

These are among the most powerful broad-spectrum (kill everything) antibiotics, and they are supposed to be used for more serious infections, but are used too widely. They may be given in women’s urinary infections, even though other antibiotics or even supplements and herbs may be effective. If you are traveling to Africa or Asia a travel doctor or your family doctor may give these to you. They can also be found in some eye drops.

The United State Food and Drug Administration – the FDA – has put “Black Box Warnings” on these antibiotics, in 2008 warning consumers that fluoroquinolones cause spontaneous complete rupture of tendons, and, in 2013, that fluoroquinolones cause nerve damage called neuropathy. Here is their 2016 additional warning. Patients of ours have reported having had psychotic events taking fluoroquinolone antibiotics, and in an early 2018 FDA communication, mental health issues and hypoglycemic coma are added as warnings. Late in 2018, the FDA announced that fluoroquinolones may cause deadly rupture of the aorta.

You’d think that this would change standard medical prescribing patterns, and it may have somewhat, but these are still too commonly prescribed.

Taking these particular antibiotics can weaken, loosen ligaments throughout your body. This resultant widespread tissue damage is permanent, potentially making some joints in your body unstable to one extent or another. Many patients don’t notice new joint pain right away, but in time the loosening of joints leads to gradually increasing damage of parts inside the joint.

In some patients’ cases, we can trace their joint damage to times of taking these antibiotics. Click here for one such case. In this case a heavier amount of Cipro and Levaquin were taken, and the patient suffered spontaneous ruptures of one Achilles’ tendon and rotator cuff tendons in both shoulders. What is often missed in the medical literature is that folks like these also have weakening of many other areas of ligament, tendon, cartilage, muscle, and nerve, setting them up for broad chronic pain. While the above link tells one very dramatic story, understand that we also see some lesser damage in patients who only took Cipro or Levaquin very briefly.

We normally require that patients have at least 2 months between consumption of fluoroquinolones and the beginning (or resumption) of PRP Stem Cell procedures. And, we require rehabilitation through IV therapy with magnesium and glutathione, and perhaps other nutrients. Oral magnesium and oral antioxidants will be of some help, but the IV nutrients are dramatically stronger. There are trails of evidence in the medical literature for key roles for magnesium and anti-oxidants in limiting damage from fluoroquinolones, and then also remediating such damage. Click here to read the abstract of a 2011 review article, in a peer reviewed journal, regarding musculoskeletal damage from fluoroquinolone antibiotics. Healthcare professionals may want to purchase the full text and study this well written review article.

Click here to watch this 14 minute documentary from Canadian TV called “Bitter Pill: The Dangerous Side Effects of Fluoridated Antibiotics”. Go to Dr. Joseph Mercola’s website to read his great 2014 article on the topic, as well as his 2019 update.

Immune Suppressive Drugs

It was already mentioned above that corticosteroids are immune suppressive. In the above section we were mostly referring to situations where patients are given corticosteroids temporarily. In unusual other situations, Prednisone may be given permanently, or for protracted lengths of time, for some severe or life-threatening illnesses, or to suppress immune system rejection of an organ transplant. There are other drugs in this category as well.

Psoriasis, rheumatoid arthritis, and other inflammatory conditions are treated with a newer category of drugs called TNF inhibiters. Examples include Embrel, Humira and others. Since these powerful drugs turn off parts of your immune system, and since our tissue regeneration procedures depend on a functional immune system, we see these medicines as contraindicated with PRP Stem Cell Therapy and our related methods.

Chemotherapy

Much of chemotherapy works with a mechanism similar to the fluoroquinolone antibiotics discussed above. Chemo drugs cause severe oxidation which breaks down cancer cells much like oxidation breaks down iron to iron oxide (rust). Unfortunately, this means that various other tissues in the body may break down as well. This break down environment is the opposite of the build up environment that we seek. If you are getting chemotherapy, PRP Stem Cell Therapy should wait.

Think Twice About These Drugs

Statins – Cholesterol Suppressing Drugs

We do not prohibit use of statin drugs during PRP Stem Cell Therapy, but maybe we should. What is scientifically clear is that at least in some partial percentage of patients, statin drugs damage muscle tissue, as well as nerve, ligament, and tendon tissue. Click here for articles and studies that discuss that effect. Statin drugs also cause deficiency of CoQ10, a critical nutrient for cell and heart health; if you do take cholesterol suppressing drugs, at least supplement with CoQ10 or the more absorbable form called ubiquinol. And, unfortunately, research has found that “Physicians seem to commonly dismiss the possibility of a connection” of statins to these proven detrimental side effects. Recent research that firmly links statin drugs, and the whole strategy of lowering cholesterol, to dementia and Alzheimer’s disease. But don’t you need to take drugs to lower your cholesterol? Dr. Mercola says your doctor is wrong about cholesterol.

Birth Control Pills and Some Hormone Medicines

Birth control pills can be gradually damaging to ligaments and tendons, as may some pharmaceutical manufactured hormone drugs. Instead, we recommend compounded (not manufactured) natural bioidentical hormones that are balanced in an ongoing manner with a healthcare provider, such as Dr. Celeste Skardis, willing to meet with you often and ideally educate you in making small day to day adjustments in hormone crèmes applied to your skin.

Other Antibiotics

Fluoroquinolone antibiotics like Cipro and Levaquin are listed above in the prohibited category. They are grossly damaging to tendons, ligaments, cartilage, nerves, etc. But we also recommend caution whenever possible in use of other antibiotics as well. For example, many people experience fatigue following antibiotic use, and we can only infer that your response to our healing process may be somewhat slowed or weakened by consumption of antibiotics. We can usually proceed with our process when a patient is on antibiotics, but in an ideal world it would be great to avoid the weakening antibiotics entirely, if it were safe to do so.

We understand that most of you will tend to want to do what your doctor says, and any infection can have serious consequences. We are not telling you to ignore you doctor’s recommendations. One option is to establish a standing relationship with a wholistic doctor as your primary doctor, or as an additional doctor. The key is to establish a relationship and to plan ahead with them on what to do with any future infection. Hopefully, you can arrange to have some natural medicines in your medicine cabinet, and enough knowledge of what to use as soon as there is any worry of an infection, together with established access by phone to your wholistic doctor. Many infections can be handled without antibiotic drugs, but you have to work very quickly with a knowledgeable doctor to be safe and effective.

Drugs for Anxiety, Depression, Sleep

We have just fairly recently been made us aware of potentially extreme risks from a category of drugs know as benzodiazepines. There are dozens of these drugs with various names such as Valium and Ativan. Sleep drugs like Ambien have similar concerns, as do drugs for depression, and anti-psychotic drugs in general. They all have somewhat similar actions of altering the nervous system. These drugs are extremely addictive within a very short time period of usage, they have many side-effects, including sometimes paradoxically amplifying the very symptoms they are meant to treat. Since they effect the nervous system, they sometimes may add to your pain, and possibly make you more anxious about your pain.

This article by Dr. Joseph Mercola cites German scientific research that claims that antidepressant drugs are no better than placebo, and that several natural supplements have better results with depression.

A strong FDA warning has been issued about severe dangers of combining benzodiazepines and opiates. Possibilities of a deadly opiate overdose increase greatly if benzodiazepines are also being taken.

Beware: if you take drugs for anxiety, sleep, depression, or other psychiatric conditions, they may be adding another confusing layer of chemically induced pain. It is possible that this drug effect would amplify pain where you have localized mechanical joint problems. We can’t help you with that added layer of pain from the drugs.

We can work with patients on blood thinners like Warfarin (Coumadin), Plavix and others. Our policy is to leave it to the doctor that monitors your blood thinning medicine to determine whether to discontinue it for a few days before our injections or not. They are welcome to phone to speak with your doctor here at NMPM. We explain to them that our injections are generally not near major vessels, and most commonly ultrasound guided. As such, it is our experience that our injections are generally safe for patients on blood thinners. In recent years, the most common conclusion of the doctors monitoring these blood thinners for our patients is to have patients go forward with the injections without interrupting their daily regimen of taking that drug.

While we do commonly work with patients on blood thinners, it may be that blood thinners could make our PRP Stem Cell Procedures take a bit more time.

Tylenol (Acetaminophen)

Because Tylenol is not an NSAID anti-inflammatory, it is not prohibited during the months of PRP Stem Cell Therapy. But, at least know that it is also very risky for your liver. In fact, Tylenol (acetaminophen) is the #1 cause of liver failure in the US. Take less than the upper limit noted on the bottle. Do not consume alcohol while taking Tylenol, and best of all, try instead to use the natural medicines discussed below.

Helpful Natural Medicines

We carry a few of the below natural medicines for your convenience, but we are not a store and can’t always keep up with inventory. We encourage you to be independent of us and get these from stores in your area, or from the internet. But, you can check with us if you’d like.

In general, understand that most of these medicines need to be taken more, and longer, before they may be felt the way you’d expect some drugs to be felt. But, if you have the simple patience to do so, you can get good results, make yourself healthier overall, and avoid the adverse side effects of drugs. Dosage should be discussed with your doctor at NMPM.

To summarize that page quickly, PRP Stem Cell Therapy will be even more successful if you have a high level of Vitamin D3 in your blood – at least a lab result of between 60 and 80, and even to around 100. Vitamin D also generally reduces control chronic pain overall. We want you taking large, every single day doses of Vitamin D3, such as 15,000 IU. This particular dose is proven to be safe, and even larger daily doses have been proven to be safe.

Enzymes such as Bromelain

Enzymes are natural substances, commonly in foods, that help you digest. Proteolytic enzymes are those that digest proteins. They can be taken with food to help digest the protein in that meal. If they are taken apart from food, such as 20 or more minutes before a meal, 1 to 1.5 hours after a meal, or any other time on an empty stomach, ingested proteolytic enzymes go into your blood stream and look for proteinous debris to digest. There will be such debris in inflamed, sore joint areas. The enzymes will gradually digest that debris and help such areas drain, reducing swelling and pressure, and making any such sore, inflamed area feel more comfortable.

An analogy we use often is to compare the above effect to the use of an enzyme product called Rid-X. It may be recommended that homes with septic systems put Rid-X into their toilet once a month to digest any excess residual waste in their septic tank, thus letting the tank safely drain into the leach field and not back up sewage into the house.

The simple, inexpensive protein digesting enzyme that we most commonly recommend is bromelain, which is an enzyme from pineapple. We make recommendations on an individualized basis for each patient, but a common dose is 500 mg (one capsule), 0 to 3 times per day, apart from food. But, it is even more appealing to take this around each PRP Stem Cell procedure, sometimes up to 1000 mg (two capsules), as frequently as every 2-4 hours, for a couple of days before each procedure, the day of each procedure, and for at least a couple of days after each procedure. Ask your physician here for individualized dosage advice.

There are many, many enzyme supplements on the market. Many are good. One goal is to compare them well. Compare the potency (GDU) and the amount (milligrams) per capsule. You’ll have to sort out what enzymes in a given commercial formula are protein digesting (proteolytic), and not digestive enzymes for fat, starch, dairy, etc. We recommend against formulas that are “proprietary”, not divulging such potency and volume information. Interestingly, enzymes are the main category of medicines sold in Europe, prescription or non-prescription!

Inflammation Regulating or Balancing Herbs and Supplements

TV commercials promise instant relief from taking one drug pill. Some people may get some relatively quick temporary relief, and others won’t. The following natural medicines should not be expected to give instant relief after taking one pill. You’ll probably need to take many more pills and take them for quite a few doses to start to feel the benefits. Dose is important, so discuss details with your doctor here at NMPM. But, if you are willing to be more patient, in just a bit more time you get the intended reduction in inflammation and pain, plus numerous healthy side effects instead of the damaging effects of drugs.

Inflammation is good. Inflammation is the natural ability of your body’s immune system to rally and bring blood and various useful natural bodily chemicals to an area to help with repair. We need inflammation throughout the time that we work with your body to grow new tissue to repair your joints. Corticosteroids, Advil, Aleve, Ibuprofen, Motrin, and aspirin stop inflammation, which aborts the repair process in your joints. Instead, the following natural medicines regulate or balance inflammation, ameliorating excess inflammation without suppressing all inflammation. We encourage you, now and over time, to get to know many versions of the following healthy natural medicines.

At minimum, we recommend taking some or all of these natural medicines for for a few days before and after each PRP Stem Cell intervention. Some of you might want to take these natural substances daily, throughout the time we’re working together to repair your joints. Talk to your NMPM physician.

Ginger, yes, the plain, inexpensive ginger powder that you may already have on your spice shelf may be a very valuable medicine for you. Sprinkle it on food during or after cooking. Use a teaspoon or less to make a cup of tea. Or, buy it in capsules at any natural food store. It is very convenient as a liquid organic ginger juice. A double-blind randomized placebo-controlled clinical trial showed that ginger objectively changes the blood of knee osteoarthritis patients to be less inflammatory, and another such study had similar results. Ginger reduces cartilage wear. Ginger reduces pain of osteoarthritis. Ginger reduces inflammatory blood markers in well-trained male endurance runners. Muscle soreness after exercise is reduced by ginger. Thigh pain during cycling is reduced by ginger. Exercise endurance is increased with ginger use. A medical journal article entitled The Amazing and Mighty Ginger collects a vast number of scientific references about the valuable actions of ginger.

Astaxanthin, pronounced az-ta-zan-thin, is a red substance that comes from algae in the ocean. Astaxanthin is what makes salmon pink. Read Dr. Joseph Mercola’s latest article which states: “astaxanthin is a very potent anti-inflammatory, making it useful for virtually any inflammatory condition, including joint problems such as rheumatoid arthritis, carpal tunnel syndrome and tennis elbow… astaxanthin has 550 times stronger antioxidant power than vitamin E, and is 6,000 times more potent than vitamin C… Astaxanthin acts on at least five different inflammation pathways, making it a very potent anti-inflammatory, and maintains balance within the system… It has broad versatility and exceptional safety, even at extremely high doses…Well over 100 studies demonstrate the safety of astaxanthin, even at mega-doses as high as 500 milligrams (mg) per day.” We usually recommend 10-20 mg per day, though you may take more. We try to carry a 10 mg capsule in office for your convenience.

Boswellia is the biblical herb frankincense. We currently try to keep a cost effective brand in stock for your convenience, but there are many good boswellia products out there. Read more about boswellia here.

Curcumin is an extract of the culinary herb turmeric that makes curry yellow. It is advisable to buy products with curcumin that use one of the more effective extraction methods – MicroActive extraction, Meriva extraction, BCM95 extraction, or LongVida extraction. Look up different brands online, or read labels at the natural food store; if one of the above extraction methods is mentioned, maybe you have one of the better products. Read here about one such curcumin product, and how it helps excess inflammation in joints, and many other systems of your body.

The above three categories of helpful natural medicine are what we emphasize and prescribe at the onset of our PRP Stem Cell Therapy. The above three categories are immediately practical for patients beginning this therapy. But, there are secondarily many other natural means of helping the overall results. Generally being happy and healthy should theoretically somewhat improve your results with PRP Stem Cell Therapy. Obviously, there are a lot of possibilities of how to get to that place.

Hemp oil. Hemp is a similar looking but different plant from marijuana. Many people are using CBD oil which is from marijuana, as it is non-psychoactive, not causing you to get high. But, a recent article by Dr. Mercola says that CBD extracted from marijuana is not as effective as the whole oil of the hemp plant. You can use hemp oil, or CBD oil, topically without any problem that we perceive, just do not apply any oil or topical medicine over areas injected for the rest of that day and evening.

Medical marijuana. We do not get involved in writing prescriptions for pain medicines, including medical marijuana. For one thing, we are interventional pain management specialists and that means our involvement is very temporary, and the prescribing of such medicine is a long-term process that involves repeated monitoring over time. But, we are supportive of your seeking out medical marijuana for help with pain control. The National Academies of Science, Engineering, and Medicine in 2016 published a landmark study of all of 10,000 scientific research studies about cannabis and concluded that there is “conclusive evidence that cannabis or cannabinoids are effective: For the treatment of chronic pain in adults”. To get an overview about The Benefits of Medical Cannabis, read this article by Dr. Joseph Mercola, and watch the accompanying video. Some people report bigger help with particular joint pains, while most seem to experience it as a good additional support for feeling less pain and sleeping better.

Chinese herbal medicine. Thousands of years of written medical experience have made Chinese herbal medicine a special resource, far more advanced than other traditions of herbology. If you have qualified practitioners of Chinese herbal medicine in your area, they may be able to help regulate your inflammation, improve circulation, reduce stagnation responsible for soreness after inactivity, etc. The complex formulas of Chinese herbal medicine may be in pills, capsules, powders, or loose, dried herbs that you must cook on your own. An interesting quality is that some formulas send the herbs more to certain areas of the body. Another interesting quality is that pain in a joint might be diagnosed to be from different causes, such as dampness, cold, heat, wind, and other causes that are different than in modern Western medicine. Most of all, Chinese herbal medicines can be very effective, IF well chosen for your particular needs. And, those needs change from time to time in your body and thus need to be monitored and updated by a qualified practitioner.

Krill oil, like fish oil, has many, many whole body health benefits. It has been shown to reduce joint inflammation, including muscle soreness after activity. The inflammation regulating herbs and supplements in the prior section probably work faster and more specifically, but it may be helpful to also take krill oil. Take krill oil, not fish oil, not cod liver oil. We don’t carry it at our office, but here is a particularly pure krill oil product.

Food. There is great power in what you eat and how you eat it. Sure, this is a huge discussion, and there are numerous points of view. Just let it be said that your experience of PRP Stem Cell Therapy will at some background level be influenced by your food choices and how you eat.

Medical Conditions that Impact PRP Stem Cell Therapy

Diabetes and Pre-diabetes

Diabetes is a condition in which body parts break down. That is why blindness, diabetic neuropathy, heart disease and many more conditions come from chronic elevation of one’s blood sugar. Diabetes or insulin resistance has been called an independent cause of knee pain and degeneration, not even necessitating mechanical wear and tear in the knee. It has been nick named “sugar on the knee“.

If diabetes (and pre-diabetes) are about breakdown of tissues, and our tissue regeneration procedures are aiming at building up tissues, the two can be opposed. Diabetes, particularly poorly controlled diabetes, can slow down the achievement of results in PRP Stem Cell procedures. Our experience is that it can work, and we do treat diabetic patients, but know that keeping your blood sugar down is really, really important.

Generally, we think that diabetes and pre-diabetes can most deeply, most sustainably, be controlled and reversed with diet and exercise. We hope that our patients can find wholistic doctors or other healthcare providers who can guide them with natural methods.

Rheumatoid Arthritis and other Rheumatic Diseases

Do you have family members who have or have had rheumatoid arthritis or any other inflammatory joint disease? Tell us if that is the case. If you have actual rheumatoid arthritis, we will probably refer you out to another physician and not treat you. If the RA can get under very, very good control, we can possibly talk about you coming back to NMPM.

Other Auto-immune Diseases

RA is auto-immune disease, but there are a huge number of other auto-immune diseases that may or may not be as immediately serious as RA. But, we need to know in order to predict how much post-injection soreness you might have after PRP Stem Cell procedures. If you have any condition that might be auto-immune, working with natural medicines to regulate your immune response would be particularly recommended.

Gout

Gout is a disease in which sharp uric acid crystals build up in and around joints. Classically, they cause redness, swelling and severe pain, but realistically, we now know that such crystals can also just be a co-factor that can make some areas more painful. Classically, gout is famous for effecting the big toe, but realistically, we see gout effect places as distant as shoulders, elbows, and the neck. At minimum, you must tell us if you have any history of known gout, or at least any known joint swelling, redness and pain at any time in your past. Why do we need to know that? Because we need to manage how sore you’ll be if we perform PRP Stem Cell Therapy. Our procedures intentionally cause some inflammation, and we need to know if there are any other additional reasons for you to be unusually inflamed and sore.

Hormone Imbalance

This is a big topic. It may or may not be significant for your use of PRP Stem Cell Therapy. But, at least theoretically, imbalances of hormones could slow your response to PRP Stem Cell Therapy. We ideally think of testosterone and progesterone as anabolic (tissue building) hormones that we like to see increased. Excesses of estrogen we preliminarily think of as catabolic – having a softening or loosening effect that might not be desirable. However, the endocrine system is a very interconnected system, and really the only ultimate goal is balance. We hope you can get balanced through food, exercise, lifestyle, and, if necessary, with the prescribing of bioidentical natural hormones through a healthcare provider that is willing to frequently take time to keep up with changes in your system and guide you to become more active in adjusting your own natural hormones a bit here and there, in conjunction with that healthcare provider.

More obviously, PRP Stem Cell therapy can be inhibited by birth control pills, and by some imbalanced synthetic, non-bioidentical pharmaceutical hormone-type drugs.

Thick Blood

We might only find out how thick your blood is at your first PRP procedure, but it if is unusually thick, it could make our job a bit harder. And, we’d try to help you thin your blood also for your overall health, as thick blood is generally imbalanced and to some degree a health risk. Start by drinking large amounts of water in the week prior to each procedure.

Dehydration

Many people are dehydrated, to one extent or another. The connective tissues that we grow are packaged water, sort of like a stalk of celery. Water content makes them firm and resilient. If you chronically don’t drink enough water, your connective tissue will be vulnerable, more easily damaged.

Click here for a series of easy to read short books about the depth of the problem of dehydration in much of the population.

Understand that diuretic drinks like coffee or tea may be good for you in some ways according to recent research, but they are negatives when it comes to hydrating. If you count your cups of water, count your cups of coffee or tea as each being a -1, or a negative number that counts against the number of cups of water you drink.

Commercial sodas are just plain junk and also count against you in hydrating.

Tobacco Use

Tobacco narrows or tightens small blood vessels that bring circulation and nutrients to connective tissues like those we try to repair in your body. This choking off of peripheral circulation slows the repair of your ligaments, tendons, cartilage, etc. That doesn’t stop us, and we’ll still try, but understand that tobacco use may slow our process to one degree or another, dampening self-healing.